Inpatient Facility Coding & Compliance Alert
Policy/Reimbursement:
Is the Current Pause of QIO Reviews a Lull Before the Storm?
Check with the QIOs for your denied claims status before you take to appeals. In a yet... Read more
Is the Current Pause of QIO Reviews a Lull Before the Storm?
Check with the QIOs for your denied claims status before you take to appeals. In a yet... Read more
Policy/ reimbursement:
Are You Ready for the MACRA Overhaul of the Existing Payment Systems?
AMA wants the implementation to be postponed to July 2017. Get ready for transition to... Read more
Are You Ready for the MACRA Overhaul of the Existing Payment Systems?
AMA wants the implementation to be postponed to July 2017. Get ready for transition to... Read more
Reader Question:
Know the Difference Between Acute Care Transfer and Discharge
Question: What is the difference between a discharge and an acute care transfer? ... Read more
Know the Difference Between Acute Care Transfer and Discharge
Question: What is the difference between a discharge and an acute care transfer? ... Read more
Reader Question:
Know Whether You Need to Report POA Codes
Question: Do all the hospitals have to comply with the HAC-POA reporting to get rei... Read more
Know Whether You Need to Report POA Codes
Question: Do all the hospitals have to comply with the HAC-POA reporting to get rei... Read more
Reader Question:
Get the Right Code for Monitoring Device Insertion
Question: The provider inserted a monitoring device into the subcutaneous tissue of... Read more
Get the Right Code for Monitoring Device Insertion
Question: The provider inserted a monitoring device into the subcutaneous tissue of... Read more
You Be the Coder:
Assign a DRG Code for Pleural Effusion With Anemia
Question: A 45-year-old patient is admitted with a diagnosis of pleural effusion. T... Read more
Assign a DRG Code for Pleural Effusion With Anemia
Question: A 45-year-old patient is admitted with a diagnosis of pleural effusion. T... Read more
Policy/ Reimbursement:
Take NOTICE of the New MOON, Coming This August
Tackling the inherent issues isn’t as easy as it seems. Many Medicare beneficia... Read more
Take NOTICE of the New MOON, Coming This August
Tackling the inherent issues isn’t as easy as it seems. Many Medicare beneficia... Read more
Policy:
Don't Be in a Hurry While Texting Your Patient Orders
Read the fine print and skip the HIPAA trap. There is good news for the providers who ... Read more
Don't Be in a Hurry While Texting Your Patient Orders
Read the fine print and skip the HIPAA trap. There is good news for the providers who ... Read more
ICD-10 Update:
What's New in the ICD-10-PCS Coding Guidelines?
Watch for revised rules for multiple procedures, root operations, body parts, and more. ... Read more
What's New in the ICD-10-PCS Coding Guidelines?
Watch for revised rules for multiple procedures, root operations, body parts, and more. ... Read more
Reader Question:
Stay Away From 'Patient Dumping'
Question: What is meant by “patient dumping”? Is this something auditor... Read more
Stay Away From 'Patient Dumping'
Question: What is meant by “patient dumping”? Is this something auditor... Read more
Reader Question:
Know the Difference Between a Cross Walk and GEM
Question: What is the difference between a cross walk and a GEM? Texas Subscriber... Read more
Know the Difference Between a Cross Walk and GEM
Question: What is the difference between a cross walk and a GEM? Texas Subscriber... Read more
Reader Question:
Can Colonoscopy Be a Root Operation?
Question: While coding for a procedure, can we consider colonoscopy as a root opera... Read more
Can Colonoscopy Be a Root Operation?
Question: While coding for a procedure, can we consider colonoscopy as a root opera... Read more
Reader Question:
Do Not Count Acute Pancreatitis As MCC After Oct. 1
Question: I have heard that in the IPPS update, apart from the revisions of the ICD... Read more
Do Not Count Acute Pancreatitis As MCC After Oct. 1
Question: I have heard that in the IPPS update, apart from the revisions of the ICD... Read more
You Be the Coder:
Know the New Codes for Gastrointestinal Tumors
Question: Does the ICD-10-CM code set have new codes for gastrointestinal tumor... Read more
Know the New Codes for Gastrointestinal Tumors
Question: Does the ICD-10-CM code set have new codes for gastrointestinal tumor... Read more
Policy/Reimbursement:
Tread Cautiously With the IPPS 2017 Rule, a Pandora's Box
Hospitals give a lukewarm response to the IPPS increase of 0.9 percent, LTCHs seethe at ... Read more
Tread Cautiously With the IPPS 2017 Rule, a Pandora's Box
Hospitals give a lukewarm response to the IPPS increase of 0.9 percent, LTCHs seethe at ... Read more
Policy/Compliance:
CMS Determined on Slashing Down Avoidable Hospitalizations and Readmissions
Find your balance within CMS’s three pronged approach Reducing hospital readmis... Read more
CMS Determined on Slashing Down Avoidable Hospitalizations and Readmissions
Find your balance within CMS’s three pronged approach Reducing hospital readmis... Read more
ICD-10 Update:
Get Ready for the ICD-10 Diagnosis, Procedure and MS-DRG Codes Overhaul
Revised guidelines, additions, deletions, reimbursement mappings and more… Prep... Read more
Get Ready for the ICD-10 Diagnosis, Procedure and MS-DRG Codes Overhaul
Revised guidelines, additions, deletions, reimbursement mappings and more… Prep... Read more
Reader Question:
Split Visit Rule Can Save You a Fortune
Question: How can NPs and physicians “split” visits for Medicare patien... Read more
Split Visit Rule Can Save You a Fortune
Question: How can NPs and physicians “split” visits for Medicare patien... Read more
Reader Question:
Receive Additional Pay for ECT for Psychiatry Inpatients
Question: How do I get reimbursed when a patient with psychiatric disorder receives... Read more
Receive Additional Pay for ECT for Psychiatry Inpatients
Question: How do I get reimbursed when a patient with psychiatric disorder receives... Read more
Reader Question:
Which Provider Gets to Bill the Discharge Code?
Question: One of our patients had a complex health history and we were among four d... Read more
Which Provider Gets to Bill the Discharge Code?
Question: One of our patients had a complex health history and we were among four d... Read more
Reader Question:
What Factors Affect the DRG Payment?
Question: What are the factors that can reduce a MS-DRG payment? Illinois Subscri... Read more
What Factors Affect the DRG Payment?
Question: What are the factors that can reduce a MS-DRG payment? Illinois Subscri... Read more
You Be the Coder:
Apply Modifier 24 to Hospital Services the Right Way
Question: A cardiologist performs a pacemaker procedure on a patient in the hospita... Read more
Apply Modifier 24 to Hospital Services the Right Way
Question: A cardiologist performs a pacemaker procedure on a patient in the hospita... Read more
Coding/Reimbursement:
How to Get the Most Out of E/M Visits For Hospital Patients
Learn from these five case scenarios on core inpatient coding. When you perform E/M vi... Read more
How to Get the Most Out of E/M Visits For Hospital Patients
Learn from these five case scenarios on core inpatient coding. When you perform E/M vi... Read more
Compliance:
Use the Inpatient Codes Carefully to Avoid RAC Audits
Plus: Laparoscopic hernia repairs are under the microscope. Is it a practice in your f... Read more
Use the Inpatient Codes Carefully to Avoid RAC Audits
Plus: Laparoscopic hernia repairs are under the microscope. Is it a practice in your f... Read more
Policy:
Take in This Eye Opening Survey From Joint Commission, Pointing Out Gross Deficits
OIG surveys reveal more that 50 percent noncompliance to basic health standards. On Ma... Read more
Take in This Eye Opening Survey From Joint Commission, Pointing Out Gross Deficits
OIG surveys reveal more that 50 percent noncompliance to basic health standards. On Ma... Read more
ICD-10 Update:
Brace Yourself to Handle 3,651 New ICD-10-PCS Codes This October
Majority of code overhaul comes from the cardiovascular system. The ICD-10 codes are f... Read more
Brace Yourself to Handle 3,651 New ICD-10-PCS Codes This October
Majority of code overhaul comes from the cardiovascular system. The ICD-10 codes are f... Read more
Reader Question:
Do You Have the 96 Hour Emergency Responsibility?
Question: According to the Joint Commission standards, are organizations supposed t... Read more
Do You Have the 96 Hour Emergency Responsibility?
Question: According to the Joint Commission standards, are organizations supposed t... Read more
Reader Question:
Master the Modifier 26 Mystery
Question: When should I use modifier 26? Alabama Subscriber Answer: CPT&re... Read more
Master the Modifier 26 Mystery
Question: When should I use modifier 26? Alabama Subscriber Answer: CPT&re... Read more
You Be the Coder:
Let DRG Weight Determine Your Principal Diagnosis
Question: A patient was admitted with a chief complaint of shortness of breath. He ... Read more
Let DRG Weight Determine Your Principal Diagnosis
Question: A patient was admitted with a chief complaint of shortness of breath. He ... Read more
Reimbursement/ Policy:
Be Careful With Your Interpretations of the NCCI Manual
The NCCI Manual was initially tailored for physicians. It’s the first quarter of... Read more
Be Careful With Your Interpretations of the NCCI Manual
The NCCI Manual was initially tailored for physicians. It’s the first quarter of... Read more
Reimbursement:
Bill It Right for the Supply Items
Do not report HCPCS codes for CMS deemed supplies. Supply categorization for hospitals... Read more
Bill It Right for the Supply Items
Do not report HCPCS codes for CMS deemed supplies. Supply categorization for hospitals... Read more
Case Study:
Ward Off Breach Incidents With These 4 Actions
Take control of your BA, use multi-layered encryption methods. Yet another HIPAA breac... Read more
Ward Off Breach Incidents With These 4 Actions
Take control of your BA, use multi-layered encryption methods. Yet another HIPAA breac... Read more
ICD-10 Update:
Define Your Approach Using PCS Code's 5th Character
Choose the keywords carefully. In ICD-10 PCS coding, you must organize each of the sev... Read more
Define Your Approach Using PCS Code's 5th Character
Choose the keywords carefully. In ICD-10 PCS coding, you must organize each of the sev... Read more
Reader Question:
How to Code For a Same Day Discharge
Question: If we admit a patient to observation at 11 p.m. on Thursday and then rele... Read more
How to Code For a Same Day Discharge
Question: If we admit a patient to observation at 11 p.m. on Thursday and then rele... Read more
Reader Question:
Here's Why Your 99223 Claim Is Getting Denied
Question: We billed 99223 for initial hospital care and evaluation and management o... Read more
Here's Why Your 99223 Claim Is Getting Denied
Question: We billed 99223 for initial hospital care and evaluation and management o... Read more
Reader Question:
Tackle Claims Spanning the ICD-10 Implementation Date
Question: We have few patients who were admitted for procedures at the end of Septe... Read more
Tackle Claims Spanning the ICD-10 Implementation Date
Question: We have few patients who were admitted for procedures at the end of Septe... Read more
You Be the Coder:
Assign a DRG Code for Cervical Fusion with Anemia
Question: A 45-year-old patient is admitted with a diagnosis of cervical stenosis a... Read more
Assign a DRG Code for Cervical Fusion with Anemia
Question: A 45-year-old patient is admitted with a diagnosis of cervical stenosis a... Read more
Billing/Coding:
Know Your Facts About Off-Campus Provider Based Department "PO" Modifier
Apply “PO” to all items or services covered by OPPS in 2016. Are you havin... Read more
Know Your Facts About Off-Campus Provider Based Department "PO" Modifier
Apply “PO” to all items or services covered by OPPS in 2016. Are you havin... Read more
Reimbursement/Billing:
Score Big With These 10 Tips to Avoid Appeals
Use modifiers to your advantage, and more, says Novitas. If you spend a lot of your va... Read more
Score Big With These 10 Tips to Avoid Appeals
Use modifiers to your advantage, and more, says Novitas. If you spend a lot of your va... Read more
ICD-10 Update:
Nail Down Root Operations in ICD-10-PCS
Key: Boil down what the physician performed to match root operation definitions. Now ... Read more
Nail Down Root Operations in ICD-10-PCS
Key: Boil down what the physician performed to match root operation definitions. Now ... Read more
Reader Question:
Chart Out Your Locum Tenens Criteria
Question: One of our physicians will be taking a six-month sabbatical, so we need t... Read more
Chart Out Your Locum Tenens Criteria
Question: One of our physicians will be taking a six-month sabbatical, so we need t... Read more
Reader Question:
How Safe Is It to Replace Old Documentation?
Question: One of our physicians made mistakes on several charts and printed out new... Read more
How Safe Is It to Replace Old Documentation?
Question: One of our physicians made mistakes on several charts and printed out new... Read more
Reader Question:
Avoid Problems Due to EHR System Updates
Question: What should our practice do to prevent unintended consequences from elect... Read more
Avoid Problems Due to EHR System Updates
Question: What should our practice do to prevent unintended consequences from elect... Read more
Reader Question:
Know the Payment Thresholds for Pass-Through Drugs
Question: What is the update for 2016 regarding pass-through drugs? Wisconsin Sub... Read more
Know the Payment Thresholds for Pass-Through Drugs
Question: What is the update for 2016 regarding pass-through drugs? Wisconsin Sub... Read more
You Be the Coder:
Sync MS-DRGS 945 and 946 With ICD-10 Perspective
Question: Can you explain how inpatient admissions are assigned to Medicare Severit... Read more
Sync MS-DRGS 945 and 946 With ICD-10 Perspective
Question: Can you explain how inpatient admissions are assigned to Medicare Severit... Read more
Reimbursement:
Rejoice With Greater Flexibility in the Over Two-Midnight Rule
CMS to allow exceptions on a case to case basis, with proven medical necessity. It&rsq... Read more
Rejoice With Greater Flexibility in the Over Two-Midnight Rule
CMS to allow exceptions on a case to case basis, with proven medical necessity. It&rsq... Read more
Compliance/Policy:
Get Your New Year Resolutions In Sync With the OIG's 2016 Work Plan
Know why hospitals, nursing homes, and DMEPOS suppliers are in the limelight. Quality ... Read more
Get Your New Year Resolutions In Sync With the OIG's 2016 Work Plan
Know why hospitals, nursing homes, and DMEPOS suppliers are in the limelight. Quality ... Read more
ICD-10 Update:
Explore How PCS Organizes Root Operations
Key: Boil down what physician performed to match root operation definitions. How confi... Read more
Explore How PCS Organizes Root Operations
Key: Boil down what physician performed to match root operation definitions. How confi... Read more
Reader Question:
Get a Foothold on the Admitting Diagnosis
Question: What shall be the admitting diagnosis when the patient comes in with multiple ... Read more
Get a Foothold on the Admitting Diagnosis
Question: What shall be the admitting diagnosis when the patient comes in with multiple ... Read more
Reader Question:
Know What to Do When the Surgery Is Cancelled
Question: The anesthesiologist completed the standard preoperative visit but believed th... Read more
Know What to Do When the Surgery Is Cancelled
Question: The anesthesiologist completed the standard preoperative visit but believed th... Read more
Reader Question:
Steer Clear of Reporting Two Observation Codes on the Same Day
Question: Occasionally we place a patient in observation status for one to three days. W... Read more
Steer Clear of Reporting Two Observation Codes on the Same Day
Question: Occasionally we place a patient in observation status for one to three days. W... Read more
Reader Question:
Know the Payment Rules for Acute Care Transfers
Question: What all is included in an acute care transfer and what are the rules... Read more
Know the Payment Rules for Acute Care Transfers
Question: What all is included in an acute care transfer and what are the rules... Read more
You Be the Coder:
Assign a DRG Code for Pneumonia
Question: A 55 year old non hypertensive, non diabetic patient is admitted with a diagno... Read more
Assign a DRG Code for Pneumonia
Question: A 55 year old non hypertensive, non diabetic patient is admitted with a diagno... Read more